An arthroscopy is a type of keyhole surgery that is used both to diagnose problems with the joints and to repair damage to the joints. The procedure is most commonly used on the knees, wrists, elbows, ankles and shoulders. If you have problems with your joints, such as swelling or stiffness, and initial imaging tests have not been able to find what is causing the problem, an arthroscopy might be recommended to look at the inside of the joint. As well as allowing a surgeon to look inside a joint, an arthroscopy can also be used to treat a range of problems and conditions. For example, an arthroscopy can be used to:
-repair damaged cartilage
-remove fragments of loose bone or cartilage
-treat frozen shoulder
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During an arthroscopy, a piece of equipment called an arthroscope is used. An arthroscope is a small, flexible tube that is about the length and width of a drinking straw. Inside there is a bundle of fibre optics. These act as both a light source and a camera. Images are sent from the arthroscope to a video screen or an eyepiece so that the surgeon is able to see the joint. It is also possible for tiny surgical instruments to be passed through an arthroscope to allow the surgeon to treat conditions or problems such as those listed above.
The surgeon will make a small incision next to the joint so that the arthroscope can be inserted. One or more small incisions will also be made to allow an examining probe or, if necessary, surgical instruments, to be inserted. An arthroscopy is usually carried out under general anaesthetic. This is where the person having the procedure is put to sleep so that they do not feel any pain or discomfort. Occasionally, a local anaesthetic may be used, where the area being treated is numbed. An arthroscopy is usually performed on an out-patient basis, which means that the person being treated is able to go home on the same day as the surgery.
Before having an arthroscopy, you will usually be given an appointment to attend a pre-admission clinic.
During your appointment your general fitness will be assessed to ensure that you are ready for surgery. You will also be given information about issues such as:
The surgical team will explain the benefits and risks that are associated with having an arthroscopy. You will also be asked to sign a consent form to confirm that you agree to have the operation and that you understand what is involved.
An arthroscopy is usually carried out under general anaesthetic, although occasionally it can be performed under local anaesthetic. Your anaesthetist will explain which type of anaesthetic is most suitable for you. In some cases you may be able to express a preference. An anaesthetist is a doctor who has received specialist training in giving people anaesthetic.
If you have a local anaesthetic your joint will be numbed so that you do not feel any pain. However, you may still feel some sensations during the procedure, such as a mild tugging, as the surgeon works on the joint.
An arthroscopy will usually take 30 to 40 minutes to complete, although more extensive surgery can sometimes last for up to an hour.
An anti-bacterial fluid will be used to clean the skin over the affected joint. A small incision, a few millimetres long, will then be made to enable the arthroscope to be inserted.
One or more additional incisions will also be made so that an examining probe, or other instruments that may be required during the procedure, can be inserted.
The surgeon may fill your joint with a sterile fluid to expand it and make it easier to view. The surgeon will be able to see inside your joint using an eyepiece or a video screen. If possible, during the procedure, they will repair any damaged areas and remove any unwanted tissue.
After the procedure is complete, the arthroscope plus any attachments will be removed along with any excess fluid from the joint. The incisions will be closed using paper tape or stitches. A sterile dressing will be used to cover the incisions and the joint may also be bandaged.
An arthroscopy is generally a safe type of surgery and any complications, such as stiffness and swelling in the affected joint, are usually minor and temporary.
More serious complications are much rarer, occurring in less than 1 in 100 cases. They include:
You should contact your surgical team for advice if you think that you may have developed a complication after having an arthroscopy.
The advantages of an arthroscopy compared with traditional open surgery include: less post-operative pain
a faster recovery time
a lower risk of complications
An arthroscopy can be used to help diagnose a number of joint problems, including:
Initial tests for these types of problems usually involve the use of imaging studies such as:
If these tests don’t find anything it may be necessary to take a direct look at the inside of the joint.
An arthroscopy can also be used to assess the level of joint damage resulting from an injury, such as a sports injury, or from underlying conditions that can cause joint damage, such as:
Surgical instruments can be passed through an arthroscope, making it possible for an arthroscopy to be used to treat a range of joint problems and joint conditions. For example, an arthroscopy can be used to:
Conditions that can be treated with arthroscopy include:
The time it takes to recover from an arthroscopy can vary depending on the joint involved and whether it needs to be repaired. It is usually possible for a person to do light, physical activities one to three weeks after having surgery. Full physical activities, such as lifting and sport, can usually be resumed after six to eight weeks.
After the arthroscopy has been completed, you will be taken to a recovery room to recover from the effects of the general anaesthetic, if you have had one.
You may experience some pain in the joint that was operated on. If you do, tell a member of the hospital staff who will be able to give you painkillers.
Most people who have an arthroscopy are able to leave hospital either on the day of the surgery or the following morning. Before leaving hospital, you may have an appointment with a physiotherapist to discuss exercises for you to do at home.
It is likely that you will feel tired and light-headed after having a general anaesthetic, so you will need to ask a responsible adult to take you home and to stay with you for the first 24 hours following surgery. Most people will recover from the effects of the anaesthetic within 48 hours.
Any dressings will need to be kept as dry as possible, so you will need to cover them with a plastic bag when having a bath or shower. If your dressings do get wet or fall off, they will need to be replaced.
Exactly how long it will be before you can return to normal activities will depend on the type of surgery that you had, your general health and the type of work that you do.
As a general rule, most children can return to school within a week of having surgery and most adults are able to return to work within two to three weeks.
You will be able to drive again once it is safe for you to make an emergency stop without damaging the affected joint. For most people this is one to three weeks after surgery. Your surgeon will be able to give you a more specific recommendation.
Your surgeon will also be able to advise you about how long it will be before you can undertake strenuous physical activities, such as heavy lifting and sport. For most people this will be around six to eight weeks after surgery.
You will usually be asked to attend a follow-up appointment four to six weeks after the operation to discuss the results of the surgery, your recovery and any additional treatment that you may require.